Primary hip arthroplasty via the direct anterior approach

Abstract Background Intraoperative pelvic tilt changes that occurs during total hip arthroplasty (THA) in the supine position affects cup placement and sometimes causes malalignment. The relationship between body mass index (BMI) and pelvic movement has been reported for some procedures, but not the direct anterior approach (DAA). The purpose of this study was to investigate intraoperative pelvic tilt changes that occurs during DAA. Methods In this single-center, retrospective study, we reviewed 200 hips that underwent primary THA via DAA in the supine position using an accelerometer-based navigation system. Intraoperative changes in pelvic tilt and axial rotation from the start of surgery to cup placement were assessed using the navigation system. Preoperative clinical factors that increased pelvic tilt and axial rotation toward the surgical side by > 10° were analyzed via univariate and multiple logistic regression analyses. Results The mean pelvic tilt value increased by 7.6° ± 3.8° (95% confidence interval [CI], 7.1–8.2; range, − 5.0–19.0) intraoperatively, and the axial rotation increased by 3.2° ± 2.7° (95% CI, 2.7–3.7; range, − 13.0–12.0). Univariate analysis revealed that the group with increased pelvic tilt showed significantly greater range of abduction and internal rotation, and significantly lower BMI than the group with no increased tilt. Pre-incisional pelvic tilt was significantly greater in the group with increased axial rotation than in the group with no increased rotation. On logistic regression analysis, BMI (odds ratio [OR], 0.889; 95% CI, 0.809–0.977; p = 0.014) and the range of internal rotation (OR, 1.310; 95% CI, 1.002–1.061; p = 0.038) were predictors of large increases in pelvic tilt. No predictors of large increases in axial rotation were identified. Conclusion Significant forward pelvic tilt was observed in patients with a low BMI values and high ranges of internal rotation via THA using the DAA. Findings indicated that surgeons should pay attention to intraoperative pelvic movements, which may help identify patients with significant pelvic tilt changes.

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Acetabular and Femoral Component Positioning Using Direct Anterior Approach Versus Posterior Approach in Total Hip Arthroplasty

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00343-9 ◽

2021 ◽

Author(s):

Tarun Goyal ◽

Arghya Kundu Choudhury ◽

Souvik Paul ◽

Tushar Gupta ◽

Lakshmana Das

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Component ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Posterior Approach ◽

Direct Anterior Approach ◽

Total Hip

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Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.11.011 ◽

2021 ◽

Author(s):

Jacob A. Haynes ◽

Robert H. Hopper ◽

P. Henry Ho ◽

James F. McDonald ◽

Nancy L. Parks ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Posterior Approach ◽

Direct Anterior Approach ◽

Single Institution ◽

Total Hip ◽

Primary Total Hip Arthroplasty

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Lower Dislocation Rate Following Total Hip Arthroplasty via Direct Anterior Approach than via Posterior Approach: Five-Year-Average Follow-Up Results

The Open Orthopaedics Journal ◽

10.2174/1874325001509010157 ◽

2015 ◽

Vol 9 (1) ◽

pp. 157-162 ◽

Cited By ~ 38

Author(s):

Sachiyuki Tsukada ◽

Motohiro Wakui

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Posterior Approach ◽

Direct Anterior Approach ◽

Dislocation Rate ◽

Rank Test ◽

Consecutive Series ◽

Total Hip

Objective: The aim of the study was to compare the dislocation rate between total hip arthroplasty (THA) via direct anterior approach (DAA) and via posterior approach (PA). Methods: We compared a consecutive series of 139 THAs via DAA with 177 THAs via PA. All study patients received ceramic-on-ceramic bearing surfaces and similar uncemented prostheses. Dislocation-free survival after THA was estimated using the Kaplan–Meier survival method and compared between groups using the log-rank test. Results: In the DAA group, none of 139 hips experienced dislocations in five-year-average follow-up. In the PA group, seven hips experienced dislocations among 177 hips (4 %). The dislocation was significantly less in the DAA group compared to the PA group (p = 0.033). Conclusion: The dislocation rate of THA via DAA was significantly less than that of THA via PA.

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The minimalinvasive direct anterior approach in aseptic cup revision hip arthroplasty: a mid-term follow-up

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-018-3062-2 ◽

2018 ◽

Vol 139 (1) ◽

pp. 121-126 ◽

Cited By ~ 5

Author(s):

Marc Dominique Horsthemke ◽

Christoph Koenig ◽

Georg Gosheger ◽

Jendrik Hardes ◽

Steffen Hoell

Keyword(s):

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Revision Hip Arthroplasty ◽

Cup Revision

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5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

Journal of Clinical Medicine ◽

10.3390/jcm11020346 ◽

2022 ◽

Vol 11 (2) ◽

pp. 346

Author(s):

Ali Darwich ◽

Kim Pankert ◽

Andreas Ottersbach ◽

Marcel Betsch ◽

Sascha Gravius ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Hip Osteoarthritis ◽

Direct Anterior Approach ◽

Short Stem ◽

Total Hip ◽

The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

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